My favorite job in high school was at a video store. Yes, those places we used to go to check out the latest Hollywood blockbuster, grab some buttery microwavable popcorn, and get charged when we didn’t rewind our VHS tapes. A major perk of the job, which paid me about $3 bucks an hour, was the ability to rent any movie I wanted for free. As a teenager, I took full advantage of this and use those skills to get better at my job. I was able to make recommendations based on what the customer “liked,” and brought home a bit of pizza money along the way.
I thought I would keep this job throughout high school until that fateful day when the owner of the store told me they were shutting it down. I was pretty disappointed as this store was a mainstay in our community and my life, but totally understood when she told me how she couldn’t compete with the bigger stores (here’s looking at you, Blockbuster – but just wait, your time in the spotlight won’t last for too long).
What really made it challenging to keep the store open was the shift by the industry to move from VHS to DVDs. For most of us this was pretty cool – no more threat that the VHS would melt in the sun, no more worrying about rewinding, and no more needing to use that tracking function on your VHS player to get rid of those pesky lines that always seemed to appear at the worst times. This meant that all the old VHS tapes needed to be replaced with new, costly, DVDs. It was too much for this locally owned store to manage.
Thankfully, working at a video store gave me some pretty generalizable skills and I was able to find another job selling plants at the local nursery, which wasn’t really that different from working in a video store. I was able to connect to people, listen to what they wanted, and then point them in the general direction of the plant that might meet their requirements. It’s funny how I still use some version of those skills today.
But yet again we are back on the themes of disruption and change. If you’ve been following along the last couple of weeks you know that there is no better place I see an opportunity for both than with our mental health workforce.
The foundation to a healthy and functioning economy is our workforce. We have to have people who do the things; people who provide the services and create the products. There’s been some exciting movement in the mental health workforce the past couple of years. In recognition that there were simply not enough clinicians to meet the ongoing demand for mental health services, we’ve now got Licensed Marriage and Family Therapists and Licensed Professional Counselors eligible to bill Medicare (a decades long fight that’s now over). We’ve seen a lot more discussion on Capitol Hill about the mental health workforce. There’s even been a shift to do more with community health workers and peer support specialists - the foundational base of our workforce pyramid.
To help strengthen the base of the pyramid and bring more attention to the other members of our community who can help with mental health, a new report on workforce that focuses exclusively on our community-based workforce was published this last week. The Bipartisan Policy Center (BPC), a wonderful policy partner I’ve worked with for years released Filling the Gaps in the Behavioral Health Workforce. This report offers clear policy recommendations for the executive branch and Congress that would strengthen the role of the community-based workforce.
There are 5 major recommendations in this report.
Building a set of core competencies for behavioral health support specialists;
Creating pathways for coverage of behavioral health support specialists within Medicare and Medicaid;
Creating a pipeline program to help behavioral health support specialists become licensed behavioral health professionals;
Establishing a community-initiated care-specific demonstration grant; and
Encouraging the adoption of community-initiated care through integration of existing federal funding streams.
The addition and expansion of our workforce requires a significant understanding of how the disparate pieces fit and the numerous pathways a person can take to get to the right person at the right time who can help. The workforce described in the report are meant to be complementary to the existing clinical system and existing structures while opening up new doors for people to find someone who can help. While this workforce challenges us to think beyond the traditional walls of a clinic, in the end the goal is the same: Get people help and see them improve. There's plenty of work to go around, and as our communities know all too well, while we wait for help, we languish. There has to be more of an immediate way to get help; this community based approach is a tenable solution to do just that.
There’s a lot here to unpack so I encourage you to read the report or watch the full live stream of the release event here:
This report, a first of its kind, offers a new paradigm for how we can think about the mental health workforce. But it goes beyond that by also offering concrete steps policy makers can make today. One of the best ways to see models like Community Initiated Care, which I have been writing about here to scale, is to find a financing or a policy mechanism to help. Now that we have these recommendations from BPC, it’s on us to put them into action and advocate for them to become a reality.
Workforce is an essential and foundational component for any attempts to address population health. Without a rethinking of who does what, where, and for whom, we remain in a place of stasis - stuck thinking that we will someday have the solution to the never ending supply and demand problem. With the emergence of promising practices, technology, and the public's openness to embracing mental health, now is the time to embrace a more radical move to address our workforce. We all know that so many of the rate limiting factors bringing new models to scale was the political and policy direction. The BPC report is an important step as it pushes us a bit, forces us to really go beyond the traditional architecture of who helps address mental health in our communities. This is a big deal and one that I think we will see the impact from for years to come.
"Workforce is an essential and foundational component for any attempts to address population health. Without"
This is an excellent piece that speaks to the need and what meeting that need can deliver. Being a very old person w/o a degree in MH all I can do is support these efforts. Though a few years ago I discovered crisis counseling as a volunteer. I do that work (volunteer=work for free) nearly daily. So I guess in the abstract I'm engaged at a community level.
Not sure that counts since being a volunteer, in any field, is kind of meh to those organizations. I do know that I can put out emotional couch fires. The system as you present needs to help but the house fires out.